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[Acute cholecystitis: video-laparoscopic or laparotomic treatment? Role of the immune system]
M Schietroma1, A Risetti, F Carlei
1Cattedra di Chirurgia Generale, Università degli Studi, L'Aquila.
Insights
Laparoscopic cholecystectomy (LC) in acute cholecystitis patients preserves immune function better than open surgery. This minimally invasive approach reduces post-operative immunosuppression and complications, leading to improved patient outcomes.
Area of Science:
- Immunology
- Surgical Oncology
- Gastroenterology
Background:
- Laparoscopic cholecystectomy (LC) is considered less invasive than open cholecystectomy.
- Previous studies suggest LC may cause less depression of cell-mediated immunity.
Purpose of the Study:
- To investigate and compare the immune response in patients with acute cholecystitis undergoing LC versus open cholecystectomy.
- To assess the impact of surgical approach on immune activity and post-operative morbidity.
Main Methods:
- Immune activity was evaluated in 28 patients (16 open, 12 LC) before and after surgery (days 1, 3, 6).
- Parameters included neutrophils, lymphocyte counts and subpopulations, HLA-DR, 6-Interleukin, and skin multitests.
Main Results:
- Open cholecystectomy led to a significant increase in neutrophils and 6-Interleukin one day post-surgery, unlike LC.
- Skin tests showed hypo- or anergic responses in 81.8% of open surgery patients versus 10.5% of LC patients.
- Monocyte antigen HLA-DR was reduced after open surgery, which was also associated with a higher incidence of respiratory tract infections.
Conclusions:
- Laparoscopic cholecystectomy for acute cholecystitis avoids post-operative immunosuppression.
- LC demonstrates better post-operative morbidity compared to open surgery.
- Minimally invasive surgery preserves immune competence, suggesting clinical advantages.
Abstract:
Recent clinical studies suggest that laparoscopic cholecystectomy (LC) causes less depression of cell-mediated immunity than open cholecystectomy. LC is a so called "mini invasive" surgical presidia, and on the basis of this consideration we have investigated if and how the immune response is modified in patients with acute cholecystitis after laparoscopic cholecystectomy compare to patients undergone open cholecystectomy. Immune-activity (neutrophils, total lymphocytes count, lymphocytes subpopulations, HLA-DR, 6-Interleukin, skin multitests) was evaluated in 28 patients 24-36 hours before surgery and p.o. after 1, 3 and 6 days: 16 patients underwent "open" cholecystectomy and 12 LC. One day after surgery patients with open cholecystectomy showed significant increase (p < or = 0.05) of plasma neutrophils and 6-Interleukin, while these parameters were almost unchanged in patients with LC. Moreover, skin tests showed ipo or anergic response in the majority (81.8%) of patients with "open" surgery compare to patients with LC (10.5%): (p < or = 0.05). Finally monocyte antigen HLA-DR was also reduced in patients with "open" cholecystectomy: in this group we also recorded 2 cases (12.5%) of respiratory tract infection. In conclusion, LC for acute cholecystitis, avoids p.o. immunosuppression with better p.o. morbidity compare to open surgery.